misuse controlled prescription drugs,* use
illicit drugs† 9 or engage in some
combination of these forms of substance use
but do not meet clinical diagnostic criteria
for addiction. Risky use can result in
devastating and costly health and social
consequences, including the disease of
addiction. Risky users are targets for public
health efforts aimed at reducing risky use
and of medical and other health professional
efforts to prevent risky use from progressing
to the disease of addiction.To determine the scope of risky substance use
and addiction in the United States, CASA
Columbia examined national prevalence data‡
for the total U.S. non-institutionalized
population ages 12 and older. For these
analyses, we examined current (past 30 day) use
of tobacco, alcohol and other drugs and the rate
of addiction involving these substances. Our
definition of addiction in this report is consistent
with the parameters used in the national survey
upon which our analyses are based--the National
Survey on Drug Use and Health (NSDUH)--
which categorizes respondents on the basis of
diagnostic criteria used in the Nicotine
Dependence Syndrome Scale (NDSS) for
nicotine dependence and in the DSM-IV for
- For data analysis purposes, the national survey
examined for this report defines misuse of controlled
prescription medications more generally as “taking a
controlled prescription drug not prescribed for you or
taking it in a manner not prescribed for the
experience or feeling it causes.” The misuse of over-
the-counter medications also constitutes risky use;
however, rates of risky use in this report do not
include the misuse of these medications since they
are not measured directly in the national surveys that
were analyzed for this study.
† Substances controlled (either through prohibited or
restricted use) through the federal Controlled
Substances Act of 1970 which created a system for
classifying illicit and prescription drugs according to
their medical value and their potential for misuse. In
this analysis, illicit drugs include marijuana/hashish,
cocaine/crack, heroin, hallucinogens, Ecstasy,
methamphetamine and inhalants.
‡ The most recent data available (2010) from the
Substance Abuse and Mental Health Association’s
(SAMHSA) National Survey on Drug Use and
Health (NSDUH).
alcohol and other drug abuse or dependence.
We also examined variations in the rates of risky
use and addiction by age, gender and race/
ethnicity. Because of the heightened
vulnerability to addictive substances while the
brain is still developing,§ 10 we present data for
the following age groups: 12- to 17-year olds;
18- to 25-year olds; and those ages 26 and older.
While the NSDUH was used for these analyses
to present consistent data across age groups, it is
important to note that these data appear to
underestimate rates of current substance use
among adolescents by at least half.** 11Risky Substance Users .......................................................................................................
Approximately one-third (31.7 percent) of the
U.S. population ages 12 and older (80.4 million
people) currently†† use one or more addictive
substances in ways that threaten their own health
and safety--including increasing the risk of
addiction--or the health and safety of others, but
do not meet clinical criteria for addiction.
(Table 3.1) Nearly one-third (30.6 percent) of
risky users engage in risky use of two or more
substances. Alcohol is the substance most
frequently implicated in risky substance use,
followed by tobacco.^12§ See Chapter II.
** Because the NSDUH is conducted in the home
where an adult must be present, reported prevalence
rates for teens are significantly lower than reported
rates in school-based surveys where greater
anonymity is assured. For example, the Youth Risk
Behavior Survey’s (YRBS) prevalence estimates for
12- to 17-year olds are 2.15 to 2.75 times as high as
those presented in the NSDUH.
†† In the past 30 days.